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state owned enterprises

State owned enterprises are deprecated as "monopolies" officially, a word which makes creating new ones FTA-illegal, except in dire emergencies in WTO members, The WTO (and also associated but separate agreements such as the US backed TISA which is supposed to be merged with the WTO GATS eventually) is attempting to privatize all of them eventually. So they are framed as a quasi-crime, a sort of theft of profitmaking entitlements from business. Similarly, that means all businesses everywhere, and their workers may be included in the entitlement, its not limited by country.

Total Cost of Uninsured Woman's COVID-19 Treatment: $34,927.43

She was uninsured. It appears that she didn't even spend any time in an ICU, she received outpatient care in an emergency room. Wouldn't it be great if we had Medicare for All? Except there is one little problem, both candidates, Biden and Trump- unless Bernie pulls off a miracle would veto it. There is a really simple reason for that. WE SIGNED AWAY THE RIGHT TO REGULATE HEALTH INSURANCE MORE THAN 20 YEARS AGO in the GATS agreement, part of the WTO, but the country never got the memo!

A Country in Denial, and not just about COVID-19

With our for-profit system being too expensive for the vast majority of Americans to afford without being bankrupted, due to very very high rates of uninsurance and underinsurance, a very great fear is that this COVID-19 epidemic will be the straw that breaks the camels back.

The Effects of International Trade Agreements on Canadian Health Measures: Options for Canada with a View to the Upcoming Trade Negotiations (2002)

Richard Ouellet, Laval University (October 2002) -- "It will be noted that while Canada has avoided the potential effects that the international economic agreements could have on health care, it has done so by taking advantage of the structure of agreements based on quite different approaches. • If the Canadian government wishes to continue exempting our public health systems from the effects of these agreements, it will have to acknowledge that doing so by simultaneously using approaches as different as those of the GATS and the NAFTA is not without risks. What is needed is an integrated approach that reflects trade concerns while respecting the health care priorities of governments."

American Health Care Horror Stories: An Incomplete Inventory

The statistics demonstrating the scope of our nation’s healthcare crisis are appalling enough. Two of three Americans report skipping needed care each year due to cost, including not filling prescriptions or putting off doctor visits. Millions are forced to borrow money to pay medical bills, leading to crushing debt. Others can’t get the care they need even by borrowing, and suffer fatal consequences: physician researchers estimate tens of thousands of Americans die each year due to inability to afford care.

Sanya Reid Smith explains what TISA does in a way people should be able to see blocks Medicare For All

A new Medicare For All (as opposed to one that pre-existed GATS and the WTO) seems to conflict with everything TISA stands for. Note that TISA is also supposed to be merged with GATS in the future. Medicare For All would be a ""new monopoly" (forbidden by GATS) and a "state owned enterprise" that "affects trade in" "financial services" (health insurance for example) Altering the conditions of competition, and it also would potentially be trade distorting. It also would not be "no more burdensome than necessary" (to ensure the quality of the service) as the WTO GATS requires. The scope of those affected would likely also be seen as far too large for any government measure. As long as we are in these deals it would likely have to be the least possible.

Medicaid Expansion in Health Reform Not Likely to “Crowd Out” Private Insurance

"Contrary to claims by some critics, the Medicaid expansion in the new health reform law will overwhelmingly provide coverage to people who otherwise would be uninsured, rather than shift people who already have private coverage to Medicaid." --- comment: This concept of "crowd-out" was literally created by the GATS and it's concept of minimal trade restrictiveness which requires that all government-subsidized measures be the most minimal possible - as well as possibly time limited, for example, only available to either an individual for only a few years, or possibly a country - for only a short period, perhaps a decade or less, (or perhaps only if they are and remain an LDC) . In this case, Medicaid is kind of a loan, not an insurance program, as it is subject to repayment, and only available to the destitute, and near destitute with assets that will only become available at their deaths, such as a home - after their other options have been used up. This "prevents healthcare prices from falling", and "preserves the profit in selling insurance", and "the value of the insurance companies investment". These are the most important things in a for-profit healthcare system. Especially as it becomes "The one bright spot in a dismal economy"

PharmaMyths.net

The drug pricing policy web site of pricing expert Donald W. Light.

How the World Trade Organisation is shaping domestic policies in health care

(The Lancet) "The previous round of WTO ministerial talks (the Uruguayan round) allowed governments to protect health and social services from GATS treatment by defining them as government services. According to GATS Article 1.3, a government service is one “which is supplied neither on a commercial basis, nor in competition with one or more service suppliers”. Article 19 of GATS is, however, intended to end this protection. “Members shall enter into successive rounds of negotiations . . . with a view to achieving a progressively higher level of liberalisation.” The WTO secretariat has argued that for services to be classified under Article 1.3 they should be provided free. Many governments initially protected health services from GATS treatment by defining them in this way. But the WTO has highlighted the inconsistencies in this approach. 12 “The hospital sector in many counties . . . is made up of government-owned and privately-owned entities which both operate on a commercial basis, charging the patient or his insurance for the treatment provided. Supplementary subsidies may be granted for social, regional, and similar policy purposes. It seems unrealistic in such cases to argue for continued application of Article I:3, and/or maintain that no competitive relationship exists between the two groups of suppliers of services.” In addition, Article 13 of GATS calls for the end of subsidies that distort trade and requires members to negotiate procedures to combat them. Therefore, according to the WTO, wherever there is a mixture of public and private funding, such as user charge or private insurance, or there are subsidies for non-public infrastructure, such as public-private partnerships or competitive contracting for services, the service sector should be open to foreign corporations. Health-care systems across Europe are vulnerable on all these counts."

GATS and Financial Services Deregulation by Patricia Arnold

Medicare, Social Security and other governmentally subsidized financial services are put in grave danger by the GATS - This paper by a noted professor in accounting who has written a great deal of highly readable material on the WTO and its interaction with financial regulation is a short and concise intro to many of the major issues, particularly the threats GATS poses to Social Security and Medicare if those areas are allowed to compete with commercial banks or insurers. Caution is needed because millions could see huge changes in their only retirement benefits just as they were needed the most if Social Security and/or Medicare lose their protection from GATS rules, which is likely if current proposals are implemented,- see the Annex on Financial Services.

GATS and Public Service Systems

This is a must-read article as its by far the most concise and understandable explanation of the "governmental authority exception" an all important "two-pronged test" or definition, that defines the scope of what is allowed to be a public service and what is not, in the GATS agreement. In other words, what is subject to privatization rules, and what isn't. This definition is also borrowed or imported, in the computer programming sense, "as is" into hundreds of other trade agreements all around the globe. So this essay is extremely useful in understanding which healthcare or higher education proposals could work (and which ones would be subjected to a death of a thousand cuts, and couldn't) for example. The essay was originally written and published by the government of British Columbia province in Canada.

The Potential Impact of the World Trade Organization's General Agreement on Trade in Services on Health System Reform and Regulation in the United States. (2009)

This paper is perhaps one of the best introductions to the GATS and healthcare issue for Americans on this site. In this 2009 paper, the late Nicholas Skala, explains the "GATS" agreement, and its implications for US healthcare reform and why we urgently need to apply for and pursue a specific procedure (Article XXI) to withdraw from the GATS in order to avoid built in traps for the unwary, for example, to get sustainable public health care. If you only read a few papers on GATS on this site, make sure this is one and also read the materials on GATS Article I:3 and 'governmental authority exclusion" keyword. Also see "explainer" tagged items.